Natural history of kidney graft survival, hypertrophy, and vascular function in end-stage renal disease type 1 diabetic kidney-transplanted patients - Beneficial impact of pancreas and successful islet cotransplantation
Natural history of kidney graft survival, hypertrophy, and vascular function in end-stage renal disease type 1 diabetic kidney-transplanted patients - Beneficial impact of pancreas and successful islet cotransplantation
复制标题
DOI：
10.2337/diacare.28.6.1303
复制
发表时间：
2005-06-01
期刊：
影响因子：
16.2
通讯作者：
Secchi, A
中科院分区：
文献类型：
--
作者：
Fiorina, P;La Rosa, S;Secchi, A
目的：糖尿病、高血压、感染和某些免疫抑制药物（如钙调磷酸酶抑制剂）的肾毒性可降低移植肾的功能性存活。我们的目的是评估终末期肾病（ESRD） 1型糖尿病患者移植肾后的生存、肥厚和血管功能。研究设计和方法：研究人群包括234例ESRD 1型糖尿病患者，他们接受了肾-胰腺（KP， 166例）、成功的肾-胰岛（ki， 24例）和肾脏（KD， 44例）移植。肾脏大小、移植物存活、血管功能和微量白蛋白尿每年进行前瞻性评估，持续6年。在1993年至1998年期间（肾移植后3.2 +/- 0.3年），进行了68例常规肾活检。结果：KP组和KI-s组6年累积肾移植存活率优于KD组（KP: 73%; KI-s: 86%; KD: 42%, P < 0.01）。KP组而KI-s/KD组没有持续的肾移植肥大，随访时间长达6年。从基线到第6年，KD组肌酐水平明显升高（1.58 +/- 0.08至2.78 +/- 0.44 mg/dl, P < 0.05），但KP/KI-s组没有。从基线到第6年，KP/KI-s组仅显示肾阻力指数降低（基线KP: 0.74 - 0.01至0.68 +/- 0.01%,P < 0.01；基线KI-s: 0.72 +/- 0.02至0.69 +/- 0.02%,P < 0.05）。在第6年，只有KD组尿白蛋白排泄量较基线有所增加（31.4 +/- 9.0至82.9 +/- 33.6 mgA, P < 0.05）。初步数据显示，KP/KI-s组的移植物一氧化氮（NO）表达高于KD组（数据未显示）。结论：在ESRD 1型糖尿病患者中，与KD相比，KP和KI-s可提高移植肾存活、肥厚和血管功能。
OBJECTIVE - Diabetes, hypertension, infections, and nephrotoxicity of certain immunosuppressive drugs (i.e., calcineurin inhibitors) can reduce functional survival of the kidney graft. Our aim was to evaluate survival, hypertrophy, and vascular function of the kidney graft in end-stage renal disease (ESRD) type 1 diabetic patients after transplant.RESEARCH DESIGN AND METHODS - The study population consisted of 234 ESRD type 1 diabetic patients who underwent kidney-pancreas (KP; 166 patients), successful kidney-islet (KI-s; 24 patients), and kidney (KD; 44 patients) transplant. Kidney size, graft survival, vascular function, and microalbuminuria were evaluated prospectively yearly for 6 years. Sixty-eight protocol kidney biopsies were performed routinely between 1993 and 1998 cross-sectionally (3.2 +/- 0.3 years from kidney transplant).RESULTS - The KP and KI-s groups had better cumulative kidney graft survival at 6 years than did the KD group (KP: 73%; KI-s: 86%; KD: 42%, P < 0.01). The KP group but not the KI-s/KD groups showed a persistent kidney graft hypertrophy up to 6 years of follow-up. A significant increase in creatinine levels from baseline to year 6 was evident in the KD group (1.58 +/- 0.08 to 2.78 +/- 0.44 mg/dl, P < 0.05) but not in the KP/KI-s groups. The KP/KI-s groups only showed a reduction of renal resistance index from baseline to year 6 (KP at baseline: 0.74 - 0.01 to 0.68 +/- 0.01%, P < 0.01; KI-s at baseline: 0.72 +/- 0.02 to 0.69 +/- 0.02%, P < 0.05). At year 6, an increase from baseline in urinary albumin excretion was observed only in the KD group (31.4 +/- 9.0 to 82.9 +/- 33.6 mgA, P < 0.05). Preliminary data suggested that graft nitric oxide (NO) expression was higher in the KP/KI-s groups than in the KD group (data not shown).CONCLUSIONS - In ESRD type 1 diabetic patients, KP and KI-s compared with KD resulted in enhanced kidney graft survival, hypertrophy, and vascular function.